Nursing Elites

1. A nurse in a clinic is caring for a client who came to be tested for tuberculosis (TB) after a close family member tested positive. The nurse should know that which of the following is a diagnostic tool used to screen for TB?

• A. Sputum culture for acid-fast bacillus (AFB)
• B. Mantoux skin test
• C. BCG vaccine
• D. Chest X-ray

Correct answer: B

Rationale: The Mantoux skin test, also known as the tuberculin skin test, is a diagnostic tool used to screen for tuberculosis (TB). It involves injecting a small amount of tuberculin under the top layer of the skin on the forearm and then checking for a reaction within 48-72 hours. This test helps identify individuals who have been exposed to the TB bacteria. Sputum culture for acid-fast bacillus (AFB) is used to confirm TB diagnosis in individuals suspected of having active TB. The BCG vaccine is used to prevent severe forms of tuberculosis in high-risk individuals but is not a diagnostic tool. While a chest X-ray can show signs of active TB disease, it is not a primary diagnostic tool for screening purposes.

2. A client is telling the nurse in the clinic that he gets a headache after taking sublingual nitroglycerin (Nitrostat) for his angina pain. Which of the following should the nurse instruct the client to do?

• A. Reduce the nitroglycerin dose
• B. Ask the provider to prescribe a strong analgesic
• C. Lie down in a cool environment and rest
• D. Ask the provider to prescribe a different medication

Correct answer: C

Rationale: The correct answer is to instruct the client to lie down in a cool environment and rest after taking sublingual nitroglycerin for angina pain. Headaches are a common side effect of nitroglycerin due to its vasodilatory effects, and resting in a cool environment can help alleviate the headache. Reducing the nitroglycerin dose is not recommended without consulting the healthcare provider as it may compromise the effectiveness of the medication in managing angina. Asking for a strong analgesic is not appropriate since the headache is likely related to the nitroglycerin and not a separate issue requiring a pain reliever. Requesting a different medication should also involve consulting the healthcare provider to ensure an appropriate alternative is prescribed for angina management.

3. A client with chronic obstructive pulmonary disease (COPD expresses difficulty in bringing up bronchial secretions. Which action should the nurse take to help the client with tenacious bronchial secretions?

• A. Maintaining a semi-Fowler's position as much as possible
• B. Administering oxygen via nasal cannula at 2 L per min
• C. Helping the client select a low-salt diet
• D. Encouraging the client to drink eight glasses of water daily

Correct answer: D

Rationale: Encouraging the client to drink eight glasses of water daily is the most appropriate action to help with tenacious bronchial secretions in COPD. Increased fluid intake can help in thinning the mucus, making it easier for the client to cough up and clear secretions. This addresses the client's difficulty in bringing up bronchial secretions. Maintaining a semi-Fowler's position can aid in breathing but does not directly address the issue of clearing secretions. Administering oxygen may be necessary for COPD, but it does not specifically target the tenacious secretions. Selecting a low-salt diet can be helpful in managing COPD in general, but it does not directly address the client's current concern of clearing bronchial secretions.

4. A client is receiving oxygen therapy via a nasal cannula. The nurse should explain that this method of oxygen delivery does which of the following?

• A. Delivers a specific concentration of oxygen constantly
• B. Delivers a high concentration of oxygen
• C. Delivers a low concentration of oxygen
• D. Restricts the client's ability to eat, speak, or drink

Correct answer: A

Rationale: A nasal cannula is a device used for delivering supplemental oxygen to patients. It delivers a specific concentration of oxygen constantly, typically ranging from 1-6 liters per minute. This method is effective for patients who require low to moderate levels of oxygen. Choices B and C are incorrect because a nasal cannula does not deliver a high concentration of oxygen and is not considered a low concentration delivery method. Choice D is incorrect because a nasal cannula does not restrict the client's ability to eat, speak, or drink; it allows them to perform these activities while receiving oxygen therapy.

5. A nurse in a community health center is assessing the results of the purified protein derivative (PPD) testing she performed to screen for tuberculosis (TB). She interprets which of the following results as positive for a 6-year-old client with no risk factors for TB?

• A. 4-mm erythema
• B. 5-mm induration
• C. 10-mm wheal
• D. 15-mm induration

Correct answer: D

Rationale: The correct answer is D: 15-mm induration. In PPD testing, an induration (hardened raised area) of 15 mm or more is considered positive for TB in individuals with no risk factors. Choices A, B, and C are incorrect because an erythema of 4 mm, induration of 5 mm, or wheal of 10 mm are not indicative of a positive TB test result in a low-risk individual. Therefore, the interpretation of a 15-mm induration would lead the nurse to consider the test positive for TB in this case.

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